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CRE that are non-susceptible to all commercially available antibiotics threaten to return us to the pre-antibiotic era. Using Single Molecule Real Time (SMRT) sequencing we determined the complete genome of a pandrug-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic> isolate, representing the first complete genome sequence of CRE resistant to all commercially available antibiotics. The precise location of acquired antibiotic resistance elements, including mobile elements carrying genes for the OXA-181 carbapenemase, were defined. Intriguingly, we identified three chromosomal copies of an IS<jats:italic>Ecp1<\/jats:italic>-<jats:italic>bla<\/jats:italic><jats:sub>OXA-181<\/jats:sub> mobile element, one of which has disrupted the <jats:italic>mgrB<\/jats:italic> regulatory gene, accounting for resistance to colistin. 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